Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts
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Key result
Mechanical circulatory support with Impella-based strategies provides effective hemodynamic stabilization and may promote disease-modifying myocardial recovery in patients with fulminant myocarditis.
Population
Patients with acute fulminant myocarditis with cardiogenic shock
Design
Review
Authors
Discussion
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Implication
May support Impella in fulminant myocarditis shock; hypothesis-generating and requires prospective RCTs before practice change.
Key Points
- This review examines the effectiveness of mechanical circulatory support in patients with acute fulminant myocarditis.
- Overview of left-sided Impella use as sole mechanical support and in combination with RV support devices.
- Analyzes evidence from endomyocardial biopsies regarding myocardial recovery.
- Discusses weaning strategies and timing for discontinuing unloading in fulminant myocarditis.
- Left ventricular unloading by Impella showed disease-modifying effects important for myocardial recovery.
- The PROPELLA concept allows for prolonged support in awake, mobilized patients for several weeks.
- Combination strategies with ECLS and Impella RP are highlighted as effective for managing cardiogenic shock.
Structured PICO
P
Population
A review discussing mechanical circulatory support strategies, including a case report of prolonged LV-Impella use, for patients with acute fulminant myocarditis and cardiogenic shock.
I
Intervention
Mechanical circulatory support (MCS) using left-sided Impella alone or in combination with right ventricular support devices (ECLS/ECMELLA or Impella RP/BI-PELLA), including the PROPELLA concept (LV-IMPELLA 5.0 via axillary approach for several weeks)
This review highlights the role of Impella-based mechanical circulatory support, including novel concepts like PROPELLA, for stabilizing and promoting myocardial recovery in patients with acute fulminant myocarditis and cardiogenic shock.
Limitations
- Mechanistic data demonstrating the effect of LV unloading on fulminant myocarditis are lacking
- Heterogeneity of presentation makes it difficult to determine appropriate weaning times
- Need for larger scale clinical trials to validate these concepts
Cite This Study
Tschöpe et al. (2018) conducted a review in Fulminant myocarditis with cardiogenic shock. Mechanical circulatory support (Impella-based strategies) was evaluated. Mechanical circulatory support with Impella-based strategies provides effective hemodynamic stabilization and may promote disease-modifying myocardial recovery in patients with fulminant myocarditis.
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